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PubMed1992

[An immunohistochemical and ultrastructural survey on smooth muscle tumors of the alimentary tract].

33 cases of smooth muscle tumors of the alimentary tract were analysed. Among them, 18 cases showed positive reaction to desmin, including one out of two cases of esophageal neoplasms, 6 out of 11 cases of gastric neoplasms, 5 from 12 cases of small intestinal neoplasms, 6 from 8 cases of large intestinal neoplasms, 14 out of 21 cases of benign tumors as well as sarcomas in grade I, and 4 from 12 cases of sarcomas in grade II and III (only mild positive result obtained in grade II and III-sarcomas). S-100 protein staining was performed in 27 cases and positive reaction was obtained only in five. Among them, 2 cases showed prominent positive reaction. 20 cases were studied by electron microscopy, and cytoplasmic myofilaments as well as dense bodies were demonstrated in 7 cases. All of them were the benign neoplasm or sarcoma in grade I. The conclusion is that most stromal tumors of the digestive system are originating from the smooth muscle, except very few cases are neurogenic in origin.

Desmin↗
PubMed1997

Pathology of esophageal cancers: local experience and current insights.

Esophageal cancer is very popular in Hong Kong. The tumor is often prevalent in males and has a modal peak of occurrence in the 7th decade. The pathogenesis of the esophageal neoplasm is still uncertain but likely to be multi-factorial. The commonest histological subtype is squamous cell carcinoma. Besides, mucoepidermoid carcinoma/adenosquamous carcinoma, adenocarcinoma, small cell carcinoma, sarcomatoid carcinoma, adenoid cystic carcinoma, undifferentiated carcinoma, melanoma and gastrointestinal autonomic nerve tumor are also found in a minority of patients. The proportion of various histologic subtypes is different from the Western populations. Concerning the genetic alternation, P53 mutation is common in esophageal squamous cell carcinoma. Esophageal cancer has its unique pattern of P53 mutations in Hong Kong. In addition, intramural metastasis and multiple lesions are characteristic features in esophageal squamous cell carcinoma. Important pathologic factors in determining the prognosis of patients with esophageal cancer includes completeness of surgical resection, stages, tumor dimension as well as MIB-1 scores and the presence of P53 mutations.

Carcinoma, Adenosquamous↗
PubMed2000

Suppression of N-nitrosomethylbenzylamine-induced rat esophageal tumorigenesis by dietary feeding of auraptene.

The modifying effects of auraptene on N-nitrosomethylbenzylamine (NMBA)-induced esophageal tumorigenesis were investigated in male F344 rats. At 5 weeks of age, all animals, except those with the test chemical alone and control rats, received s.c. injections of NMBA (0.5 mg/kg body weight/injection, three times per week) for 5 weeks. At the end of the study (20 weeks), 75% of the rats treated with NMBA alone had esophageal neoplasms (papillomas). However, the groups who received a dose of 500 ppm auraptene during the initiation phase developed significantly reduced incidence of tumors (39%; P<0.05). Exposure to auraptene (500 ppm) during the post-initiation phase also decreased the frequency of the tumors (29%; P<0.01). The reduction of the incidence of severe dysplasia was obtained when auraptene was administered in the post-initiation phase (P<0.05). Cell proliferation in the esophageal epithelium determined by proliferating cell nuclear antigen (PCNA) was lowered by auraptene (P<0.01). Blood polyamine contents in rats who received NMBA and the test compound were also smaller than those of rats that received the carcinogen (P<0.05). These findings suggest that dietary auraptene is effective in inhibiting the development of esophageal tumors by NMBA when given during the initiation as well as post-initiation phases, and such inhibition is related to suppression of cell proliferation in the esophageal epithelium.

Animals↗
PubMed1983

Polypoid epithelial malignancies of the esophagus.

Polypoid epithelial malignancies of the esophagus are rare tumors. One hundred fifty cases of epithelial malignancy of the esophagus accessioned to the Registry of Radiologic Pathology at the Armed Forces Institute of Pathology were reviewed with respect to morphologic and pathologic characteristics. Only large intraluminal polypoid epithelial masses were analyzed. Criteria used to select cases were: (1) size greater than 4 cm, (2) expansion of the esophageal lumen by the bulky tumor, and (3) absence of constriction or wall infiltration. Twenty-two lesions met these criteria (15 spindle cell carcinomas, two carcinosarcomas, three squamous cell carcinomas, and two oat cell carcinomas). When an esophageal neoplasm is polypoid and bulky, creates a "cupola" effect, has scalloped edges, expands the lumen of the esophagus, and is pedunculated, one must consider spindle cell carcinoma as the primary diagnosis.

Aged↗
PubMed2000

Suppression of N-nitrosomethylbenzylamine-induced rat esophageal tumorigenesis by dietary feeding of 1'-acetoxychavicol acetate.

The modifying effects of 1'-acetoxychavicol acetate (ACA) on N-nitrosomethylbenzylamine (NMBA)-induced esophageal tumorigenesis were investigated in male F344 rats. At 5 weeks of age, all test animals, except those given the test chemical alone, and the control rats received s.c. injections of NMBA (0.5 mg/kg body weight/injection, three times per week) for 5 weeks. At the termination of the study (20 weeks), 75% of rats treated with NMBA alone had esophageal neoplasms (papillomas). However, the groups given a dose of 500 ppm ACA during the initiation phase developed a significantly reduced incidence of tumors (29%; P<0.01). Exposure to ACA (500 ppm) during the post-initiation phase also decreased the frequency of the tumors (38%; P<0.05). A reduction of the incidence of preneoplastic lesions (hyperplasia or dysplasia) was obtained when ACA was administered in the initiation phase (P<0.01). Cell proliferation in the esophageal epithelium, determined by assay of proliferating cell nuclear antigen (PCNA), was lowered by ACA (P<0.05). Blood polyamine contents in rats given NMBA and the test compound were also smaller than those of rats given the carcinogen (P<0.05). These findings suggest that dietary ACA is effective in inhibiting the development of esophageal tumors by NMBA when given during the initiation or post-initiation phase, and such inhibition is related to suppression of cell proliferation in the esophageal epithelium.

Animals↗
PubMed1984

Endoscopic laser therapy for gastrointestinal disease.

As recently as 1981, less than 12 medical centers in the United States were using lasers for the treatment of gastrointestinal (GI) disease. Now they are being used in more than 200 American medical centers and the number is increasing. There are several causes for this increase: (1) the applications for the treatment of GI disease have expanded; (2) they are relatively easy to use; (3) they can be cost-effective if the same laser can be used by more than one subspecialty; and (4) lasers may provide therapeutic options where limited ones previously existed. In the past six months, the Food and Drug Administration ruled that lasers were no longer classified as investigational devices for certain GI applications (eg, upper GI bleeding or obstructing esophageal neoplasms). Most importantly, in most instances, they have been safe and effective. With the technology related to lasers and endoscopes advancing to rapidly, an even greater use of lasers for the field of GI disease, in specific, and medicine, in general, can be anticipated.

Biliary Tract Diseases↗
PubMed2006

Surgical treatment of esophageal leiomyoma: an analysis of our experience.

INTRODUCTION: leiomyoma is the most common benign esophageal neoplasm. Surgical treatment (enucleation) has traditionally been the therapy of choice. The advent of minimally invasive techniques has produced an increase in endoscopic approaches to the detriment of open surgery. OBJECTIVE: the aim of this study was to compare the results obtained with open surgery and with laparoscopic surgery in this kind of pathology. MATERIAL AND METHODS: we performed a retrospective study of all leiomyomas operated for in our center between 1986 and 2004, and obtained 9 cases of esophageal leiomyoma. Four were women and five men, between the ages of 40 and 70, with a mean age of 53.5 years. The most frequent symptoms were heartburn (5 cases), dysphagia (3 cases), and retrosternal pain (3 cases). Surgery was in all the cases an enucleation. An open approach was performed in 5 cases (3 thoracotomies and 2 laparotomies), and an endoscopic approach in 4 (2 thoracoscopies and 2 laparoscopies). RESULTS: the mean postoperative hospital stay was 5.12 days (range 2-8 days). This was shorter for endoscopic approaches versus open surgery (3.25 vs. 7 days). There was no case of esophageal mucosal perforation or reconversion. No death, intraoperative complication, or tumor relapse was described. Only 2 patients had complications: post-surgical thoracic pain, and intestinal obstruction by adhesions 8 years after surgery. CONCLUSION: enucleation is an easier procedure and constitutes the therapy of choice for esophageal leiomyoma. This approach has to be laparoscopic. We think that muscle borders should be closed after enucleation, and that biopsy is not indicated preoperatively.

Adult↗
PubMed2003

Leiomyosarcoma of the esophagus.

Leiomyosarcomas of the esophagus are rare, malignant, smooth-muscle tumors. The presenting symptoms are indistinguishable from other esophageal neoplasms, though the history may be longer due to the slow growth of these tumors. Barium studies may show large intramural masses with ulceration or tracking, expansile intraluminal masses or areas of luminal narrowing. Endoscopic biopsies may give a high false negative rate especially in cases where the mucosa is intact. The treatment of choice is surgical excision. Synchronous and metachronous metastases do not preclude surgery, provided the metastases are also resectable. Prognosis is better than in patients with squamous esophageal cancer. The role of adjuvant radiotherapy and chemotherapy is controversial. We report a 40-year-old man who presented to us with dysphagia and was found to have a leiomyosarcoma of the esophagus. He was treated successfully with esophagectomy and is disease-free after 7 years. We review the literature on esophageal leiomyosarcomas and their management.

Adult↗
PubMed2006

Amelanotic malignant melanoma of the esophagus. Report of a case.

Primary malignant melanomas of the esophagus are rare neoplasms with aggressive behavior and tendency to lymphatic and hematogenous spread. We report on a patient affected with a primary amelanotic melanoma of the esophagus synchronous to a squamous cell carcinoma of the epiglottis and treated by subtotal esophagectomy. A 58-year-old woman presented with a three-month history of dysphagia, retrosternal pain and weight loss. An upper gastrointestinal endoscopy revealed a 3 cm, non pigmented, polypoid mass of the middle esophagus and biopsy was consistent with undifferentiated carcinoma. Fiberoptic bronchoscopy revealed a 0.5 cm, polypoid lesion of the right aspect of the epiglottis consistent with a squamous cell carcinoma. The esophageal neoplasm was treated by subtotal esophagectomy while the squamous cell carcinoma of the epiglottis was referred to radiotherapy 1 month after surgery. Microscopy showed diffuse proliferation of anaplastic cells with multiple mitotic figures, marked nuclei and multilobulated nucleoli. The neoplasm stained positive for HBM-45 antigen and S-100 protein. Tumor stage was pT1N0M0. Review of patient's medical history and exploration of skin and mucous membranes failed to reveal malignant lesions and definitive diagnosis was primary amelanotic malignant melanoma of the esophagus. The patient died 16 months after surgery of disseminated disease. In conclusion the present case confirms that primary malignant melanomas of the esophagus have a dismal outcome even in cases of early-stage lesions amenable to surgical resection.

Carcinoma, Squamous Cell↗
PubMed1985

[Endocavitary radiotherapy in an after-loading technic in malignant stenoses of the upper gastrointestinal tract and bile ducts].

Palliative brachytherapy with 192iridium in high dose rate technique was applied until August 1985 in 44 patients: 40 suffering from an inoperable malignant stenoses of the esophagus or cardia, and 4 from bile duct carcinomas located in the upper part of the duct. The patients with malignant stenoses of the upper gastrointestinal tract underwent laser therapy until an endoscope could be passed beyond this stenoses. Then an after-loading tube was placed endoscopically and the stenoses irradiated endocavitarily (7/Gray/session in 1 cm distance). In the patients with malignant bile duct obstruction a PTCD-catheter served to guide the iridium wire up to the stenotic region.

Adenocarcinoma↗
PubMed2000

[Solitary renal metastasis of primary esophageal cancer].

We present an unusual case of single kidney metastasis from an primary esophageal neoplasm. Its main clinical and diagnostic topics are described. They made us consider him as a good candidate for surgery. The pathological study of the nephrectomy specimen was surprising. The postoperative period was unfortunate, however.

Aged↗
PubMed1990

A misdiagnosed case of neurinoma of the 8th cranial nerve and adult respiratory distress syndrome.

A case of a 81-year old female patient with a clinically non-verified neurinoma of the 8th cranial nerve is presented. According to symptoms and radiological examinations, esophageal neoplasm with esophago-tracheal fistula was suspected. The patient died on the 4th day after radiological examination due to progressive respiratory failure. Autopsy revealed neurinoma of the 8th cranial nerve as well as adult respiratory distress syndrome due to aspiration of the radiological contrast medium.

Aged↗
PubMed2005

Minimally invasive pharyngo-laryngo-esophagectomy: a salvage procedure for recurrent postcricoid esophageal cancer.

Hypopharyngeal and cervical esophageal tumors represent 5-10% of all esophageal neoplasms and are challenging for both surgeons and oncologists, because the choice of the adequate therapeutic strategy is not clearly defined and therefore difficult. In fact, although surgical treatment represents the gold standard of therapy, chemo-radiotherapy, previously used as adjuvant treatment, has been more recently adopted with curative intent, leaving to surgery a salvage role only. When surgery is required it is advisable to reduce patients' trauma. The present study reports on a personal technique for minimally invasive pharyngo-laryngo-esophagectomy and reconstruction with the whole stomach. We use a laparoscopic approach for mobilization of the stomach, transhiatal esophageal dissection and to follow transhiatal gastric transposition to the neck combined to a cervicotomy to perform pharyngo-laryngectomy, proximal esophageal mobilization, and pharyngo-gastric anastomosis. We performed this technique on four patients with recurrent disease after initially curative primary chemo-radiotherapy. Mean operative time was 345 min (range: 300-384). There were no intraoperative complications. All patients were extubated immediately after the operation and were managed in postoperative care unit for a mean time of 10 days (range: 7-12). Enteral nutrition was begun on post-operative day (POD) 1. The nasogastric tube and drainages were removed on POD 11, and patients immediately started oral nutrition. One patient had a TIA (transient ischemic attack) on POD 2. All patients were discharged within 20 days (18-20). Initial experience with this minimally invasive technique in selected patients is encouraging because it seems to minimize postoperative complications and allows early rehabilitation.

Aged↗
PubMed2000

The role of multimodality therapy for resectable esophageal cancer.

BACKGROUND: There is an increasing interest in the role of combined therapy to achieve long-term survival for patients with resectable esophageal neoplasms. Surgery provides excellent palliation with relatively low morbidity and mortality rates, but cure remains elusive. MATERIAL AND METHODS: From January 1988 to January 1998, a total of 137 patients met eligibility criteria for a combined multimodal therapy, prospective, nonrandomized protocol of induction chemoradiation therapy followed by surgical resection, based on radiological and endoscopic assessment of the extension (all patients were initially considered to be at clinical stages I to III, locoregional). Consequently, patients with high grade Barrett's dysplasia or any squamous carcinoma in situ (stage 0) and those with distant metastatic disease (stage IV) were excluded. Among this group, 48 operable patients with biopsy-proven esophageal cancer finally entered and completed the protocol and are the sample of the present study. Multivariate logistic regression models were used to identify risk factors for death or recurrence. Actuarial survival was calculated since the beginning of the induction protocol by the Kaplan-Meier method, and comparisons between groups were made by the log-rank test. RESULTS: Mean age was 61.6 (range 45 to 71), and 72.9% were male. The majority of the tumors (70.8%) were located at the lower third/cardia and as many as 18.8% were adenocarcinoma. After a mean of 7.5 weeks (range 5 to 12) after the completion of the induction phase, 68.7% underwent a transthoracic esophagectomy and 31.3% a transhiatal esophagectomy. The in-hospital mortality rate was 10.4% (5 patients). A complete response (no evidence of tumor within the specimen: pT0) was achieved in 25% (12 patients). After a mean follow-up of 20.2 months, mean survival for the entire group was 18.2 months (95% confidence interval 14 to 22). At the end of the study, 25% (12) remained alive. Actuarial survival rates at 12, 23, and 37 months were 56.2%, 36.9%, and 21.9%, respectively. CONCLUSIONS: Esophageal resection after induction therapy seems to be related to a slightly higher mortality rate compared with historical series, and for this reason, neoadjuvant therapy must be considered still experimental. However, no statistical significant difference in survival is showed in those cases with complete pathological response (pT0). Factors influencing survival are recurrence and age. Surgery alone remains the standard therapy for esophageal cancer.

Aged↗